Dealer Credit Application

Credit Application Download: If you would prefer to print out the Credit Application Form and mail it in, please click here for a printable copy in PDF format. You must have Adobe Acrobat Reader to be able to do this. You can mail the application to: Whitewater Designs, 520 Commercial St., Eugene, OR 97402.

Company Information

Company Name:

Store Owner/Manager:

Email Address:

Billing Address:

City:

State:

Zip:

Shipping Address:

City:

State:

Zip:

Phone Number:

Fax Number:

Accounts Payable Contact:

Resale Number:

Year Established:

Credit Information

Bank Name:

Bank Officer's Name:

Address:

City:

State:

Zip:

Phone Number:

Fax Number:

Account Number:

Trade References

(Must be filled out completely)

Trade Reference #1

Company Name:

Account Number:

Address:

City:

State:

Zip:

Phone Number:

Fax Number:

Trade Reference #2

Company Name:

Account Number:

Address:

City:

State:

Zip:

Phone Number:

Fax Number:

Trade Reference #3

Company Name:

Account Number:

Address:

City:

State:

Zip:

Phone Number:

Fax Number:

Your Questions or Comments:

We hereby apply for credit and certify that the information above is correct. We agree to the terms outlined by Whitewater Designs and agree to meet these terms if credit is extended. Our understanding is that this information is for use of your Credit Department only and will be held in confidence. If any invoices are placed for collection, all costs and expenses will be our responsibility.

Enter the verification code numbers in the box to the right. (required)